Dryden Mark J, Dogan Basak E, Fox Patricia, Wang Cuiyan, Black Dalliah M, Hunt Kelly, Yang Wei Tse
1 Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030.
2 Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
AJR Am J Roentgenol. 2016 May;206(5):1112-8. doi: 10.2214/AJR.15.14715. Epub 2016 Mar 23.
The objective of this study was to compare the potential influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques.
A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded.
Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL preoperatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8-7.0) or more than one seed (OR, 7.03; 95% CI, 1.6-30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5-1.5) (p = 0.75).
Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use of one versus more than one seed or wire did not.
本研究的目的是比较术前放射性种子定位（RSL）和金属丝定位（WL）技术后成像变量对手术切缘的潜在影响。
2012年5月16日至2013年5月30日期间，共有565例患有660个乳腺病变的女性接受了RSL或WL。记录患者年龄、病变类型（肿块、钙化、伴有钙化的肿块、其他）、病变大小、使用的种子或金属丝数量、手术切缘状态（切缘接近阳性或阴性）以及再次切除和乳房切除术率。
在660个病变中，127个（19%）术前接受了RSL，533个（81%）接受了WL。RSL组的平均病变大小为1.8 cm，WL组为1.8 cm（p = 0.35）。RSL组和WL组在病变类型上无差异（p = 0.63）。127例RSL中有105例（83%）使用单个种子进行RSL，而533例WL中有349例（65%）使用单个金属丝进行WL（p = 0.0003）。RSL（26/127，20%）和WL（104/533，20%）切缘接近阳性的病例数相似（p = 0.81）。RSL组和WL组在切缘接近阳性状态（均为20%，p = 0.81）、再次切除率（分别为20%对16%；p = 0.36）或乳房切除术率（均为6%，p = 0.96）方面无差异。与单纯肿块相比，含有钙化的病变更可能需要不止一根金属丝（优势比[OR]，4.44；95%可信区间，2.8 - 7.0）或不止一粒种子（OR，7.03；95%可信区间，1.6 - 30.0）（p < 0.0001）。病变大小增加和存在钙化是切缘阳性的显著预测因素，而使用不止一根金属丝或种子则不是（OR，0.9；95%可信区间，0.5 - 1.5）（p = 0.75）。
WL组和RSL组的切缘接近阳性、再次切除和乳房切除术率仍然相似。钙化的存在和病变大小增加在WL组和RSL组中均增加了切缘接近阳性的几率，而使用一粒与不止一粒种子或一根与不止一根金属丝则没有这种情况。
